Developing a Rural Psychiatry Training Program on The Texas-Mexico Border: A Chance for Innovation

Dingle, Arden D.; Fernandez, F; Erausquin, Gabriel A. de

doi:10.1007/s10597-021-00914-6

Cited by 4 publications

(3 citation statements)

References 14 publications

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“…Since onychophagia is a challenging disorder to treat, a multi-disciplinary approach involving primary care physicians, psychiatrists, dermatologists and dentists may be required. In the Rio Grande Valley (RGV), located in the southernmost tip of Texas, the prevalence of anxiety and depression has increased while the number of physicians struggles to keep up with demand [ 4 , 12 - 14 ]. In 2021, an estimated 27.6% of Texans reported an unmet need for counseling or therapy when it came to depression or anxiety symptoms, which was higher than the national average of 26.9% [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 2021, an estimated 27.6% of Texans reported an unmet need for counseling or therapy when it came to depression or anxiety symptoms, which was higher than the national average of 26.9% [ 15 ]. An estimated 10% of psychiatrists are expected to retire within the next couple of years and the consequences of this will have a pronounced impact in the RGV [ 4 , 12 - 13 ]. Furthermore, the lack of Spanish-speaking psychiatrists in the country, an estimated 5.5% of all psychiatrist in the United States, create language barriers that can limit access to quality care [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Rivera¹,

Marín-Aragón²,

Thomas³

et al. 2022

Cureus

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Onychophagia is a habitual nail-biting disorder, usually associated with mental or emotional diseases. It affects 20-30% of the population in all age groups. Human bites have the potential to become serious injuries due to high virulence in the human oral flora and may often require hospital admission, antibiotics and even debridement in the operating room. Thus, repetitive nail biting has the potential to be limb-threatening if not treated early and appropriately. We present a 49-year-old Spanish-speaking gentleman, with a past medical history of repetitive nail biting secondary to severe anxiety, major depression disorder, bilateral hand neuropathy secondary to diabetes mellitus (DM) type 2 who was initially admitted to the hospital due to cellulitis of the fingers with suspected osteomyelitis in the right hand. Anxiety was being treated by psychiatrist with paroxetine however, given no improvement and prolonged follow-ups, the primary care physician (PCP) added hydroxyzine and scheduled alprazolam in an attempt to minimize symptoms. Despite these efforts, patient continued with nail biting. On initial physical exam, the patient had a lack of fingernails and multiple wounds at various stages of healing across all digits. The distal and middle phalanges of the third right digit showed increased erythema and swelling and band tightening. Patient was started on broad-spectrum antibiotics. Initial radiography of the right hand was concerning for osteomyelitis which was later confirmed with Magnetic Resonance Imaging (MRI). Infectious disease specialist agreed on a course of cefepime, vancomycin and metronidazole. On admission, hand surgeon did not see a need for amputation and patient was treated conservatively. Due to minimal improvement after six days on IV antibiotics, patient underwent fasciotomy of the flexor compartment of the right middle finger after patient rejected hand surgeon's recommendation for amputation. He was discharged to a skilled nursing facility where he was to continue intravenous antibiotics for an additional four weeks. The vulnerable patient population of South Texas is predominately Hispanic, Spanish-speaking and uninsured. It is imperative to treat psychiatric disorders early to prevent complications, however, given the low numbers of psychiatrists in the Rio Grande Valley and even fewer who speak Spanish it is not unusual to find an appointment in more than six months. In this case, we observe how a trivial everyday behavior can lead to limb-threatening complications if not treated early and appropriately.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Rivera¹,

Marín-Aragón²,

Thomas³

et al. 2022

Cureus

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“…Rio Grande Valley (RGV), bordered by Mexico, is a region characterized by a long history of a close and interdependent relationship with Mexico with shared families, traditions, values, activities, and businesses; until a few decades ago, the border was relatively porous. Many still consider RGV and its close Mexican cities to be one region [17].…”

Section: Border Health Carementioning

confidence: 99%

Remedios: Coping with Mental Distress among Mexican Americans in the Rio Grande Valley

Escobar¹,

Barrera²,

Longoria³

et al. 2022

JMHSB

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The Latino population continues to increase, with estimates of 60 million living in the United States. Of the Hispanic population, 19% live in poverty. This may be a problem because according to research, living in poverty affects people’s social networks and self-worth negatively and is strongly associated with psychological issues. This study examined the perceptions of practitioners of mental health treatment of Mexican Americans who were experiencing mental distress and were residing in the U.S.- Mexico border. Findings suggest clients self-diagnose and try medications (usually purchased in Mexico) that were recommended to them by family members and/or social networks. Additionally, the family and social network behave like their own health/mental health care network, a manifestation of the Mexican American value that one should take care of one’s own. Loved ones provide these suggestions or consejos to help those struggling with mental stress manage their mental health. Professional mental health care is usually the last resort, which clients consider only after other options have been exhausted. This study reveals a need to explore the so-called family and social network health care system within this culture.

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Considerations for Rural Training Programs

Dingle

Chiriboga

2022

Graduate Medical Education in Psychiatry

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Developing a Rural Psychiatry Training Program on The Texas-Mexico Border: A Chance for Innovation

Cited by 4 publications

References 14 publications

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Bitten to the Bone: A Case of Anxiety-Induced Osteomyelitis

Remedios: Coping with Mental Distress among Mexican Americans in the Rio Grande Valley

Considerations for Rural Training Programs

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